Nursing Care and the "therapeutic use of the self".

I was in one of the last cohorts of nurses trained in a non-academic way.  We trained by apprenticeship really.  With college blocks in between placements in various areas of practise.  All nursing students shared a core initial eighteen months of training then we separated into streams related to General or Psychiatric nursing.  by the nomenclature of the times when I qualified I was a Registered "Mental" Nurse.  A source of much amusement.

I have not practised as a nurse for some years and am no longer on the Register.  I could no longer be arsed keeping up with the training requirements and the expense of Registering (the demand for ninety quid from the Nursing & Midwifery Council was the last straw).

None the less nursing was a hugely positive experience for me. I learned a great deal from working with people on what was conceivably the worst day of their lives.  That was an experience I have always taken with me.

The skills needed to communicate with someone who is thought disordered or hallucinated, the need to demonstrate empathy and acceptance were something I was exposed to in my training by working with experienced and effective nurses.  It is difficult to learn these skills from a book.

We learn  now that in England, there is a proposal that nursing students will actually have to spend a year working as health care assistants, feeding and dressing people.   The opposition to this proposal from the Tory Health Minister is led by the Royal College of Nursing keen to promote the view that nurses are not "skivvies".

My last experience of nursing was on the bank at my local psychiatric hospital.  As a bank staff nurse I would come in to work on a ward for a shift.  Typically this would be a sunday back shift (I had a day job during the week).  I would often be "special nursing" someone. Generally this means staying within arms length of someone at all times to ensure their safety.

In my shift, the regular trained staff would be in the office writing up paperwork and generally "planning" care to be delivered by Health Care Assistants. So far so good. It seems that this reflects the "professionalisation" of nursing the RCN wants to preserve.

What does this attitude convey to Health Care Assistants?  It conveys the notion that assisting people with their needs is seen as simple manual labour. Feeding, dressing, bathing people are seen as somehow the work of a "skivvy" not a nurse.  The poor wages and conditions of "untrained" Health Care Assistants really reflect rather well what society actually thinks about the notion of "Care".

Feeding, dressing or bathing someone is not a simple manual task, It presupposes a relationship.

Nurses do and (in my time at least, did) a huge variety of tasks  We didn't shirk from these tasks simply because we had the realisation that these were powerful ways of building a relationship. Of showing to our patients that we cared and that we understood.

Nurses do many tasks but all of these presuppose a relationship.  Nursing to my mind IS a relationship.  A special kind of relationship which is aimed at promoting the independence of the patient.  The nurse educator Annie Altschul described nursing as "the therapeutic use of the self".

By this definition of nursing, it is Health Care Assistants, lowly paid and poorly trained who are the "nurses", not the highly educated but poorly learned "Nurses".

Too many young nursing students are apparently being misled by nurse education and by their professional bodies into thinking all this does not matter. Au contraire it is the single most important notion of all.  Care is not simply a series of technical procedures, tasks and processes.

What is care if is not a relationship?